The financial problems of the National Health Service are once again a major source of debate in the House of Commons and the public. A 15 March report released by the Public Accounts office accuses the Government of not moving quickly enough to keep acute hospital trusts financially solvent. The Committee concluded: ‘The Committee concludes the financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable.’ Additionally the report has suffered ‘long term damage’ and that there is not a plan for closing the £22bn efficiency gap and likened the situation to being a ‘black hole’.
Not Fit For Purpose
In the past year three quarters of trusts were running deficits with overspending estimated to be £2.5bn. One matter that the report that needs to be urgently addressed is spending on agency staff and needs more workforce planning.
MP Meg Hillier (Hackney South and Shoreditch), Chair of the committee, labeled acute hospital trusts are at a “crisis point”. ‘Central government had done too little to support trusts facing financial problems, with the result that overall deficits were growing “at a truly alarming rate”, she said. Efficiency targets had made matters worse.’ She went on to say, ‘The government’s health planning was “a serious and recurring concern for this committee,’
The report concluded that ‘There is a long way to go before the taxpayer will be convinced there is a workable and properly costed plan in place to secure the future of our health service.’
If the U.K. were to exit from the European Union what effect, if any, would this have on The National Health Service?
In a 17 March report in Healthy Living Dr. Max Pemberton, Psychiatrist examined both side of the issue of whether or not leaving the EU would financially benefit the NHS. In his case for Brexit his report stated that £100bn is spent every year to operate but even with adjustments to inflation there could still be a £30bn deficit. With better efficiency plans as much as £22bn could be saved but the NHS would still have at least £8bn that would be needed to fill the financial gap.
The UK now pays up to £15bn per year to cover its membership in the EU with UK getting back £7bn in rebates and subsidies. The idea is with the UK leaving the EU there would still be a shortfall of near £8bn which could be easily the current NHS shortfall.
The next issue putting strains on the NHS is from immigration especially for maternity services as immigrants are more likely to have children than UK nationals. Britain can receive rebates when treating EU nationals in the NHS.
With immigration to the UK is at record highs the NHS hospitals received £49.7mln for providing medical care but the UK government paid out £674mln to the EU as reimbursement for treating UK citizens while they were abroad.
One of the main points Dr. Pemberton makes is that the NHS does not operate like other nations healthcare systems stating, ‘…whereby healthcare is entirely free at the point of access and entirely funded by taxpayer’s money.’ Additionally, ‘This notion of ‘nationalised risk pooling’ – whereby everyone pays in to one system that then provides for everyone who needs it – is easily abused or misused by those who can come to the UK under EU free movement legislation, receive free healthcare and then return to their country.’
One of the biggest and best resources is the staff for the NHS. It is now fifth largest employer in the world which uses 70% of the budget on staff costs. Dr. Pemberton suggests, ‘Ensuring adequate staffing levels and the right mix of skills for such an enormous organisation would be impossible without the ability to easily and readily recruit from abroad. It’s just a simple fact of life that the NHS is heavily reliant on skilled overseas workers in order to keep it afloat.’
Freedom of movement in the EU has allowed the NHS to recruit all levels of professional healthcare providers with about 10% of doctors being from the EU. The report suggests that, ‘There is also an agreement across EU countries about recognising certain healthcare qualifications and if we left the EU, this would cease and need to be renegotiated. UK medics would not necessarily have their qualifications acknowledged in other European countries, while we would not necessarily be able to accept the qualifications from overseas workers wanting to work in the NHS.’
For expats in countries such as Spain are currently able to get free GP treatment with hospital costs covered by the NHS. If the UK departed the EU Dr. Pemberton says that a Brexit could possibly upset the current arrangement forcing expats to have to pay for their own treatment as terms of treatment may be renegotiated.
Another concern in departing the EU would be a possible disruption of established partnerships that develop new healthcare treatments and advances in technology which the EU helps to fund with the UK being the largest recipient. Other programs that focus on public health issues such as alcohol and smoking could be jeopardized by an EU exit as the subsidies provided for these issues would have to be totally covered by UK taxpayers. Dr. Pemberton points out that additional fallout is possible in regards to employment law especially in the area of European Working Time Directive which guarantees that staff are not overworked and other employment rights that are now in place.
The stability of the NHS will continue to be one of the main questions for the UK public to consider for the 23 June referendum and its impact on the strength of the economy which has to remain healthy itself to keep the NHS operational.
Article by Kevin Murphy: www.kevinmurphy.london